tetracycline hydrochloride

(tet ra sye' kleen)

Achromycin, Apo-Tetra (CAN), Novo-Tetra (CAN), Nu-Tetra (CAN), Sumycin

Pregnancy Category B (Topicycline only)

Pregnancy Category D

Drug classes
Antibiotic
Tetracycline

Therapeutic actions
Bacteriostatic: Inhibits protein synthesis of susceptible bacteria, preventing cell
replication.

Indications
Systemic administration
• Infections caused by rickettsiae; Mycoplasma pneumoniae; agents of psittacosis,
ornithosis, lymphogranuloma venereum and granuloma inguinale; Borrelia
recurrentis, Haemophilus ducreyi, Yersinia pestis, Yersinia tularensis, Bartonella
bacilliformis, Bacteroides, Vibrio cholerae, Campylobacter fetus, Brucella,
Escherichia coli, Enterobacter aerogenes, Shigella, Acinetobacter calcoaceticus,
Haemophilus influenzae, Klebsiella, Streptococcus pneumoniae
• When penicillin is contraindicated, infections caused by Neisseria gonorrhoeae,
Treponema pallidum, Treponema pertenue, Listeria monocytogenes, Clostridium,
Bacillus anthracis, Fusobacterium fusiforme, Actinomyces, Neisseria meningitidis
• Adjunct to amebicides in acute intestinal amebiasis
• Uncomplicated urethral, endocervical or rectal infections in adults caused by
Chlamydia trachomatis
• Unlabeled use instilled in a chest tube: Pleural sclerosing agent in malignant
pleural effusions
• Treatment of trachoma
• Oral: Eradication of H. pylori in combination with other products
• Oral: Treatment of acne
Topical administration
• Topical dermatologic solution: Treatment of acne vulgaris
• Dermatologic ointment: Treatment and prophylaxis of minor skin infections due
to susceptible organisms

Contraindications and cautions

Systemic administration and dermatologic solution
• Contraindicated with allergy to any of the tetracyclines; pregnancy (toxic to the
fetus); lactation (causes damage to the teeth of infant).
• Use cautiously with hepatic or renal dysfunction.

Available forms
Capsules—100, 250, 500 mg; tablets—250, 500 mg; topical solution—2.2 mg/mL; oral
suspension—125 mg/5 mL

Dosages
Systemic administration
ADULTS
1–2 g/day PO in 2–4 equal doses. Up to 500 mg PO qid.
• Brucellosis: 500 mg PO qid for 3 wk with 1 g streptomycin bid IM the first week
and daily the second wk.
• Syphilis: 30–40 g PO in divided doses over 10–15 days.
• Uncomplicated gonorrhea: 1.5 g initially, then 500 mg q 6 hr PO to a total of 9 g.
• Gonococcal urethritis: 1.5 g PO initially, then 500 mg q 4–6 hr for 4–6 days.
• Uncomplicated urethral, endocervical, or rectal infections with chlamydia
trachomatis: 500 mg qid PO for at least 7 days.
• Severe acne: 1 g/day PO in divided doses; then 125–500 mg/day.
• Eradication of H. pylori: 500 mg qid in combination with other products.
Topical dermatologic solution
Apply generously to affected areas bid.
PEDIATRIC PATIENTS > 8 YR
Oral
25–50 mg/kg/day PO in 4 equal doses.

Pharmacokinetics
Route Onset Peak
Oral Varies 2–4 hr
Topical No general systemic
absorption

Metabolism: T1/2: 6–12 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces

Adverse effects
Systemic administration
• Dermatologic: Phototoxic reactions, rash, exfoliative dermatitis
• GI: Discoloring and inadequate calcification of primary teeth of fetus if used by
pregnant women, discoloring and inadequate calcification of permanent teeth if
used during period of dental development, fatty liver, liver failure, anorexia,
nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, esophageal ulcers
• Hematologic: Hemolytic anemia, thrombocytopenia, neutropenia, eosinophilia,
leukocytosis, leukopenia
• Hypersensitivity: Reactions from urticaria to anaphylaxis, including intracranial
hypertension
• Other: Superinfections, local irritation at parenteral injection sites
Topical dermatologic solutions
 • Local: Stinging, burning during application; skin irritation; dermatitis; yellowing
of areas of application

Interactions
Drug-drug
• Decreased absorption with calcium salts, magnesium salts, zinc salts, aluminum
salts, bismuth salts, iron, urinary alkalinizers, food, dairy products, charcoal
• Increased digoxin toxicity
• Increased nephrotoxicity with methoxyflurane
• Decreased effectiveness of hormonal contraceptives, though rare, has been
reported with a risk of breakthrough bleeding or pregnancy
• Decreased activity of penicillins

Nursing considerations
Assessment
• History: Systemic administration and dermatologic solution: Allergy to any of the
tetracyclines, tartrazine; hepatic or renal dysfunction, pregnancy, lactation.
• Physical: Systemic administration, topical dermatologic solution: Site of
infection, skin color, lesions; R, adventitious sounds; bowel sounds, output, liver
evaluation; urinalysis, BUN, liver and renal function tests. Dermatologic
ointment: Site of infection.

Interventions
• Administer oral medication on an empty stomach, 1 hr before or 2–3 hr after
meals. Do not give with antacids. If antacids must be used, give them 3 hr after
the dose of tetracycline.
• Culture infection before beginning drug therapy.
• Do not administer during pregnancy; drug is toxic to the fetus.
• Do not use outdated drugs; degraded drug is highly nephrotoxic and should not be
used.
• Arrange for regular renal function tests with long-term therapy.
• Use topical preparations of this drug only when clearly indicated. Sensitization
from the topical use may preclude its later use in serious infections. Topical
preparations containing antibiotics that are not ordinarily given systemically are
preferable.

Teaching points
Oral preparations
• Take the drug throughout the day for best results. The drug should be taken on an
empty stomach, 1 hr before or 2–3 hr after meals, with a full glass of water. Do
not take the drug with food, dairy products, iron preparations, or antacids.
• Finish your complete prescription; if any is left, discard it immediately. Never
take an outdated tetracycline product.
 • There have been reports of pregnancy occurring when taking tetracycline with
hormonal contraceptives. To be certain of avoiding pregnancy, use an additional
type of contraceptive.
• This drug should not be used during pregnancy; using barrier contraceptives is
advised.
• These side effects may occur: Stomach upset, nausea (reversible); superinfections
in the mouth, vagina (frequent washing may help this problem; if severe, request
medication); sensitivity of the skin to sunlight (use protective clothing and a
sunscreen).
• Report severe cramps, watery diarrhea, rash or itching, difficulty breathing, dark
urine or light-colored stools, yellowing of the skin or eyes.
Topical dermatologic solution
• Apply generously until skin is wet.
• Avoid the eyes, nose, and mouth.
• You may use cosmetics as usual.
• You may experience transient stinging or burning; this will subside quickly; skin
in the treated area may become yellow; this will wash off.

Adverse effects in Italic are most common; those in Bold are life-threatening.